| NPI | 1205928843 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JIM WIMMERSTEDT President 618-234-0202 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: IL 203000429) |
| Additional Taxonomies | 332BP3500X Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition (Licence: IL 203000429) |
| 332BX2000X Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies (Licence: IL 203000429) | |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2011-12-07 |